Health Care Directive vs. DNR vs. POLST – What’s the Difference?

When it comes to planning for end-of-life care, it can be overwhelming to navigate the various forms and documents designed to communicate your medical preferences. Three commonly used tools are an Advance Health Care Directive, a Do Not Resuscitate (DNR) order, and a Physician Orders for Life-Sustaining Treatment (POLST) form. While each serves a similar purpose of ensuring your medical wishes are honored, they differ in scope and and usage. Understanding the distinctions can help you make informed decisions about your healthcare and ensure that your end-of-life wishes are respected.

1. Advance Health Care Directive

An  Advance Health Care Directive is a legal document that outlines your preferences for medical care if you become incapacitated and cannot communicate your wishes. This document often includes instructions about the type of medical treatments you would or would not want, such as life support, pain management, or artificial nutrition and hydration.

A health care directive typically covers broader, long-term healthcare decisions, which can include:

• Whether you want life-sustaining treatments like ventilators or feeding tubes.

• Your preferences regarding organ donation.

• Appointing a healthcare agent—someone who will make medical decisions on your behalf if you’re unable to do so.

Who uses it?

• Anyone can complete a health care directive, regardless of age or current health status, as part of proactive planning for unexpected medical events or terminal illness.

When is it used?

• The document is intended for long-term planning and is often filed with your medical provider or attorney.

2. Do Not Resuscitate (DNR)

A Do Not Resuscitate (DNR) order is a specific medical directive that instructs healthcare providers not to perform Cardiopulmonary Resuscitation (CPR) if your heart stops beating or you stop breathing. It is a narrowly focused document and applies only to decisions about resuscitation efforts.

A DNR may be written by a doctor after discussing the patient's wishes or prognosis and can be either part of a broader care plan or a standalone directive.

Who uses it?

• DNR orders are often used by individuals who are elderly, terminally ill, or in a state of health where CPR would not offer a meaningful extension of life or could cause harm.

When is it used?

• A DNR order is only used in the event of a cardiac or respiratory arrest. It does not affect other medical treatments you may receive or your overall care, such as pain relief or comfort care.

3. Physician Orders for Life-Sustaining Treatment (POLST)

A Physician Orders for Life-Sustaining Treatment (POLST) form is a more detailed medical order designed for seriously ill or frail individuals who are nearing the end of life. The POLST form outlines specific medical treatments the patient wants or does not want, including resuscitation, hospitalization, and life-sustaining treatments like mechanical ventilation or feeding tubes.

Unlike a health care directive, which is a general statement of wishes, a POLST form is filled out with a physician and translates your preferences into actionable medical orders. The POLST is intended to be honored across healthcare settings—whether you’re at home, in a nursing facility, or in the hospital.

Who uses it?

• POLST forms are typically for individuals with serious illnesses or those at the end of life who want to make specific medical decisions about their care. It is particularly common among elderly patients or those in hospice care.

When is it used?

• The POLST form is meant for current, actionable medical decisions. It is used across various healthcare settings, and unlike a health care directive, it is a physician’s order, meaning it must be followed by healthcare professionals as soon as it's presented.

Conclusion

Each of these documents—Health Care Directive, DNR, and POLST—plays a crucial role in end-of-life care planning, but they serve different purposes. Understanding the differences helps ensure that you and your loved ones are fully prepared for any medical situation that may arise, allowing you to maintain control over your healthcare decisions during critical moments.

Take the time to consult with your doctor or a legal advisor to determine which forms are appropriate for your circumstances and ensure they are on file with your healthcare providers.